3‐in‐1 lumbar plexus block for muscle biopsy in malignant hyperthermia patients. Amide local anaesthetics may be used safely

Abstract

A 3-in-1 lumbar plexus block with the aid of a nerve stimulator was performed in 32 patients and a psoas compartment block was performed in five patients for muscle biopsy of the upper leg for diagnosis of malignant hyperthermia (MH) susceptibility. Twenty-two patients were found to be MH susceptible by the in vitro contracture test. Twenty patients received 40 ml prilocaine 1.5% with epinephrine 1:200,000 and two received 40 ml bupivacaine 0.5% with epinephrine 1:200,000 without any untoward reaction. The 3-in-1 block provides a high success rate and excellent analgesia for muscle biopsy of the upper leg. Amide local anaesthetics are safe in MH-susceptible patients.

Regional anaesthesia of the lower extremity in infants and children

“…The majority of reports include the use of 0.2–0.4 ml·kg −1 of 0.5% bupivacaine with a single shot administration, while two additional reports describe the use of a catheter technique and a continuous infusion (16,17). In addition to the treatment of traumatic femur fracture, other authors describe the use of femoral nerve block and its modifications (3‐in‐1 block) to provide postoperative analgesia (18–20) and as a technique to be used instead of general anaesthesia in potentially high‐risk patients (21–23).…”

“…sedation and provided adequate surgical anaesthesia without complications. Gielen and Viering (23) reported their experience with either a 3‐in‐1 lumbar plexus block in 32 patients or psoas compartment block in five patients to provide intraoperative surgical anaesthesia during muscle biopsy in patients with possible malignant hyperthermia. While the group comprised mainly adults, and the youngest patient was 15 years old, there were four patients aged less than 20 years.…”